Paradigm
®
522 and 722 Insulin Pumps
User Guide
©2008 Medtronic MiniMed, Inc. All rights reserved.
Bolus Wizard®, Dual Wave®, Guardian®, MiniLink®, Paradigm®, Paradigm Link®, Quick-serter®, Quick-set® , Silhouette®, Sof-set®, and Square Wave® are registered trademarks of Medtronic MiniMed, Inc.
CareLink™ Personal, Enlite™, and Easy Bolus™ are trademarks of Medtronic MiniMed, Inc. Energizer® is a registered trademark of Eveready Battery Company.
Glucagon Emergency Kit® is a registered trademark of Eli Lilly and Company.
Contacts: Africa:
Medtronic Africa (Pty) Ltd. Tel: +27 (0) 11 677 4800
Australia:
Medtronic Australasia Pty. Ltd. Tel: 1800 668 670 (product orders) Tel: 1800 777 808 (customer help)
Bangladesh
Sonargaon Healthcare Pvt Ltd Mobile: (+91)-9903995417 or (+880)-1714217131
België/Belgique:
N.V. Medtronic Belgium S.A. Tel: 0800-90805
Brasil:
Medtronic Comercial Ltda. Tel: +(11) 3707-3707
Canada:
Medtronic of Canada Ltd.
Tel: 1-800-284-4416 (toll free/sans-frais) China: Medtronic (Shanghai) Ltd. Tel: +86 40 0820 1981 or 80 0820 1981 Croatia Medtronic Adriatic Tel: +385 1 488 11 20 Fax: +385 1 484 40 60 Danmark:
Medtronic Danmark A/S Tel: +45 32 48 18 00 Deutschland: Medtronic GmbH Geschäftsbereich Diabetes Telefon: +49 2159 8149-370 Telefax: +49 2159 8149-110 24-Stdn-Hotline: 0800 6464633 Eire: Accu-Science LTD. Tel: +353 45 433000 España:
Medtronic Ibérica S.A. Tel: +34 91 625 05 42 Fax: +34 91 625 03 90 24 horas: +34 901 120 335
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Medtronic Europe S.A. Europe, Middle East and Africa Headquarters
Tel: +41 (0) 21-802-7000
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Medtronic France S.A.S. Tel: +33 (0) 1 55 38 17 00
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Medtronic Italia S.p.A. Tel: +39 02 24137 261 Fax: +39 02 24138 210
Servizio assistenza tecnica: Nº verde 24h: 800 712 712
Japan:
Medtronic Japan Co. Ltd. Tel: +81-3-6430-2019 Latin America: Medtronic, Inc. Tel: 1(305) 500-9328 Fax: 1(786) 709-4244 Latvija: Ravemma Ltd. Tel: +371 7273780 Magyarország: Medtronic Hungária Kft. Tel: +36 1 889 0697 Malaysia: Medtronic International Ltd. Tel: +60-3 7953 4800
Middle East and North Africa:
Regional Office Tel: +961-1-370 670 Nederland, Luxembourg: Medtronic B.V. Tel: +31 (0) 45-566-8291 Toll Free: 0800-3422338 New Zealand: Medica Pacifica Tel: +0800 106 100 24-hr After-Hours: +0800 633 487 Norge:
Medtronic Norge A/S Tel: +47 67 10 32 00 Fax: +47 67 10 32 10 POCCИЯ: Medtronic B. V. Tel: +7 495 580 73 77 24h: 8-800-200-76-36 Polska:
Medtronic Poland Sp. Z.o.o. Tel: +48 22 465 6934
Portugal:
Medtronic Portugal Lda Tel: +351 21 7245100 Fax: +351 21 7245199
Puerto Rico:
Medtronic Puerto Rico Tel: 787-753-5270
Republic of Korea:
Medtronic Korea, Co., Ltd. Tel: +82.2.3404.3600 Schweiz: Medtronic (Schweiz) AG Tel: +41 (0)31 868 0160 24-Stunden-Hotline: 0800 633333 Fax Allgemein: +41 (0)318680199
Serbia & Montenegro:
Epsilon Tel: +381 11 311 8883 Singapore: Medtronic International Ltd. Tel: +65 6436-5097 or +65 6436-5090 Slovenija:
Zaloker & Zaloker d.o.o. Tel: +386 1 542 51 11 Fax: +386 1 542 43 32
Slovenská republika:
Medtronic Slovakia O.Z. Tel: +421 268 206 944 Fax: +421 268 206 999 Sri Lanka Swiss Biogenics Ltd. Mobile: (+91)-9003077499 or (+94)-777256760 Suomi: Medtronic Finland Oy Tel: +358 20 7281 232 Help line: +358 20 7281 200 Sverige: Taiwan: Medtronic-Taiwan Ltd. Tel: +886.2.2183.6093 Fax: +886.2.2501.7680 Toll Free: 0800.082.999 Thailand: Medtronic (Thailand) Ltd. Tel: +66 2 232 7400 ext 1 Turkiye:
Medtronic Medikal Teknoloji Ticaret Ltd. Sirketi.
Tel: +90 216 4694330
USA:
Medtronic Diabetes Global Headquarters Tel: +1-800-826-2099 24 Hour HelpLine: +1-818-576-5555 To order supplies: +1-800-843-6687 United Kingdom: Medtronic Ltd. Tel: +44 1923-205167 Yisrael: Agentek Tel: +972 3649 3111 Österreich: Medtronic Österreich GmbH Tel: +43 (0) 1 240 44-0 24 – Stunden – Hotline: 0820 820 190 Česká republika:
Medtronic Czechia s.r.o. Tel: (+420-233) 059401
Important Safety Information
Regarding Your Paradigm Insulin Pump
(includes all models)
Avoid Immersing Your Pump In Water
Although it is unlikely that water damage will occur if your pump is splashed or briefly dunked, you should avoid immersing your Paradigm insulin pump in water. To swim or participate in other water activities, always disconnect from your Paradigm pump and reconnect after you are out of the water.
If you inadvertently submerge your pump in water, dry the pump quickly using a soft, clean towel and verify that it is working properly by selecting Selftest from the pump's Utilities Menu. If you believe that water has entered your pump or you observe any other possible pump malfunction, please check your blood glucose, treat high blood glucose (if necessary) with an injection and contact your local help line or representative for further assistance. Symptoms of high blood glucose include fatigue, excessive thirst and nausea. You should always contact your healthcare professional if you experience excessively high or low blood glucose levels, or if you have any questions about your care.
Electrostatic Discharge
Although your Paradigm pump is designed to be unaffected by typical levels of electrostatic discharge (ESD), very high levels of ESD can result in a reset of the pump's software with an associated pump error alarm. In most cases, exposure to high levels of ESD will trigger the pump's A-13 alarm although, under certain circumstances, high level ESD exposure can cause A-44, Bolus Stopped or Max Delivery alarms. High levels of ESD are more likely in situations where the relative humidity is very low, such as inside a heated building during the winter in areas where it is cold outside.
If your pump experiences an A-13 or other error alarm, press the ESC and ACT buttons to clear the alarm. If you are unable to clear the alarm by pressing ESC and ACT, you may need to remove and replace the pump's battery to clear the alarm. After clearing the alarm, you should always verify that your pump is set to the correct date and time and that all other settings (basal rate, max basal and bolus limits, etc.) are programmed to the desired values, since the software reset could erase your previously programmed settings. Please see the Alarms and Alerts section of this User Guide for more details regarding what to do if your pump displays an error alarm or other alert message.
Please contact your local helpline or representative to report any error alarms or other problems that occur with your pump.
Warranty
Medtronic Diabetes warrants the Medtronic MiniMed Insulin Pump against defects in materials and workmanship for a period of 4 years from the date of purchase.
During the warranty period, Medtronic Diabetes will, at its discretion, either repair or replace (with a new or recertified pump, at Medtronic Diabetes’ discretion) any defective pump or motor, subject to the conditions and exclusions stated herein. In the event that a pump is repaired or replaced, the warranty period will not be extended.
This warranty is valid only if the Medtronic MiniMed Insulin Pump is used in accordance with the manufacturer’s instructions. This warranty will not apply:
• If damage results from changes or modifications made to the pump by the user or third persons after the date of manufacture.
• If non-Medtronic infusion sets and/or reservoirs are being used with the pump.
• If damage results from service or repairs performed by any person or entity other than the manufacturer.
• If damage results from a Force Majeure or other event beyond the control of the manufacturer.
• If damage results from negligence or improper use, including but not limited to: improper storage, submersion in water or physical abuse, such as dropping or otherwise.
This warranty shall be personal to the original user. Any sale, rental or other transfer or use of the product covered by this warranty to or by a user other than the original user shall cause this warranty to immediately terminate. This warranty does not apply to batteries, infusion sets, reservoirs, and other accessories. The remedies provided for in this warranty are the exclusive remedies available for any breach hereof. Neither Medtronic Diabetes nor its suppliers or distributors shall be liable for any incidental,
consequential, or special damage of any nature or kind caused by or arising out of a defect in the product. Notwithstanding the foregoing, the terms of this warranty do not affect the statutory rights of consumers or seek to exclude any liability which is not permitted by law.
All other warranties, other than mandatory statutory warranties, expressed or implied, are excluded, including the warranties of merchantability and fitness for a particular purpose.
Contents
Chapter 1: Introduction ... 1
Assistance ... 1 Emergency kit ... 1 Consumables ... 2 Accessories ... 2How to wear your pump ... 3
How to use this guide ... 3
User safety ... 4
Indications ... 4
Contraindications ... 5
Warnings ... 5
Reservoir and infusion sets ... 5
Sensor ... 5
Transmitter ... 5
Magnetic fields ... 5
X-rays, MRIs and CT scans ... 6
Precautions ... 6
Avoid extreme temperatures ... 6
Infusion sets and sites ... 7
Sensor ... 7
Adverse reactions ... 7
Notice ... 7
Insulin pump and RF accessories ... 7
RF interference from other devices ... 8
Chapter 2: Introduction to pump therapy ... 11
Theory of insulin pump therapy ... 11
Understanding pump therapy ... 12
Basal rate ... 12 Meal bolus ... 12 Gram counting ... 12 Exchange counting ... 12 BG targets ... 12 Insulin sensitivity ... 12 Active Insulin ... 13
Blood glucose and A1C testing ... 13
BG testing ... 13
A1C ... 13
Low blood glucose (hypoglycemia) ... 14
Hypoglycemia protocol: the rule of 15 ... 15
High blood glucose (hyperglycemia) ... 16
Hyperglycemia protocol ... 16
Diabetes ketoacidosis (DKA) ... 17
Preventing DKA ... 17
Sick day management ... 18
Sick day protocol ... 18
Sick day supplies ... 18
Nutrition ... 19
Carbohydrate counting ... 19
Carbohydrate gram counting ... 19
Carbohydrate exchange system ... 19
Reading a food label ... 20
Fat and blood glucose ... 21
Protein and blood glucose ... 21
Other things that affect blood glucose ... 22
Healthy eating habits ... 22
Exercise ... 22
Chapter 3: The basics ... 25
Your pump ... 25
Battery ... 29
Time display ... 30
Reservoir volume ... 30
Alert and alarm icons ... 30
Sensor icons ... 30 Scroll bar ... 31 Screen backlight ... 31 Beep/vibrate ... 31 Operating modes ... 31 Normal mode ... 32 Special mode ... 32 Attention mode ... 32 Menus ... 33 MAIN MENU ... 33 BOLUS MENU ... 33 SUSPEND ... 33 BASAL MENU ... 33 SENSOR ... 33 PRIME MENU ... 34 UTILITIES MENU ... 34 STATUS screen ... 34
If you remove your pump ... 35
Chapter 4: Basic programming ... 37
Setting the time and date ... 37
Selecting the language ... 39
Bolus ... 39
Setting the Normal bolus ... 40
Normal meal bolus using the exchange system ... 41
Bolus practice: ... 41
Normal meal bolus practice using exchanges ... 42
Normal meal bolus using carbohydrate counting ... 42
Normal meal bolus practice using carbohydrates ... 43
Meal bolus, correction bolus and insulin sensitivity ... 43
Practice: Meal bolus ... 44
Review your bolus deliveries ... 44
Bolus details ... 45
Maximum bolus limit ... 47
Example 1: Max bolus ... 47
Example 2: Max bolus ... 47
BG Reminder ... 47
Basal ... 48
Start and stop times ... 49
Your basal settings ... 50
Basal programming and delivery ... 50
Current basal delivery ... 51
Daily basal rate(s) ... 51
Setting the Max basal rate ... 52
Example 1: Max basal ... 52
Example 2: Max basal ... 53
Stopping your pump ... 53
Resume pump delivery ... 54
Example: Suspend function ... 54
Practice: Suspend function ... 55
Practice: Resume basal delivery after a suspend ... 55
Chapter 5: Starting on insulin ... 57
Prepare your pump for use ... 57
Filling the reservoir ... 57
Filling the reservoir ... 58
Changing your infusion set ... 60
Removing the reservoir ... 60
Rewinding your pump ... 60
Inserting the reservoir in your pump ... 62
Manual prime ... 63
Inserting the infusion set ... 64
Quick-set infusion set (with Quick-serter®) ... 66
Fixed prime ... 66
Prime history ... 67
Chapter 6: Using the Bolus Wizard feature ... 71
What is it? ... 71
Carbohydrate counting ... 71
Your blood glucose reading ... 71
Your personal Bolus Wizard feature settings ... 71
How the Bolus Wizard feature works ... 74
Bolus Wizard warnings ... 75
HIGH BG ... 75
LOW BG ... 75
MAX BOLUS EXCEEDED ... 75
How to program the Bolus Wizard feature ... 75
Turning on the Bolus Wizard feature ... 76
Selecting the Carb units ... 76
Setting the Carb/Exch ratios ... 77
Setting the BG units ... 78
Insulin sensitivity ... 78
Setting the BG Targets ... 79
About active insulin ... 80
Active insulin time ... 81
Review your Bolus Wizard feature settings ... 81
Meter option ... 82
Meter rules ... 82
Add, delete, review meter IDs ... 83
Normal bolus using Bolus Wizard feature ... 84
Bolus Wizard feature examples ... 85
Example 1: Blood glucose on target (normal blood glucose) and no active insulin ... 86
Example 2: Blood glucose above target (high blood glucose) and no active insulin ... 87
Example 3: Blood glucose below target (low blood glucose) and no active insulin ... 88
Example 4: Blood glucose above target (high blood glucose) with active insulin ... 89
Example 5: Blood glucose below target (low blood glucose) with active insulin ... 90
Chapter 7: Optimizing pump therapy ... 91
Square Wave and Dual Wave bolus ... 91
Turning on the Dual Wave/Square Wave option ... 92
Square Wave or Dual Wave bolus without Bolus Wizard feature ... 92
Square Wave bolus practice ... 94
Dual Wave bolus practice ... 95
Using the Bolus Wizard feature for a Square Wave or Dual Wave bolus ... 95
Easy bolus ... 97
Easy bolus setup ... 97
Step value setup ... 98
Delivering Easy Bolus ... 98
Example 1: Easy bolus ... 99
Your turn: Easy bolus practice ... 100
Basal patterns ... 100
Turning on the patterns ... 101
Programming a pattern ... 101
Select a pattern ... 102
Example 1: Basal patterns ... 102
Example 2: Basal patterns ... 103
Your turn: ... 103
Temp basal rates ... 103
How does temp basal work? ... 103
Temp basal types ... 104
Insulin rate (U/H) ... 104
Percent of basal ... 105
Chapter 8: Sensor features ... 111
Entering your sensor settings ... 111
Turning on the sensor ... 111
Selecting the BG units ... 112
High Glucose Alert ... 112
Setting the High Snooze ... 112
Low Glucose Alert ... 113
Setting the Low Snooze ... 114
Setting the Alarm Snooze ... 114
Setting the Cal Reminder ... 115
Entering the transmitter ID ... 115
Setting up the Missed Data feature ... 116
Charging the transmitter ... 118
Starting the sensor ... 119
Inserting the Enlite™ sensor ... 119
Connecting the transmitter to the sensor ... 124
Preparing the sensor for communication ... 125
Calibrating the sensor ... 125
Entering meter BG ... 126
Re-starting the sensor after three days ... 127
Chapter 9: Using your sensor ... 129
Status screens ... 129
Reading the sensor glucose graphs ... 130
Opening and viewing the graphs ... 131
The graphs ... 132
Examples of continuous sensor glucose graphs ... 133
3-hour graph ... 133
24-hour graph ... 134
How to check for rapid changes in sensor glucose ... 135
The rapid change arrows ... 135
Calibration history ... 136
Sensor alarm history ... 136
Disconnecting the transmitter and removing the sensor ... 136
Disconnecting the sensor from the transmitter ... 136
Removing the sensor ... 137
Storage ... 137
Using your system in water ... 137
Chapter 10: Utilities ... 139
Alarm review ... 139
Setting your alert type ... 139
Auto-off ... 140
LOW RESV WARNING (Low reservoir warning) ... 140
Review daily insulin totals ... 141
Pump data management ... 142
Meter blood glucose information ... 142
Personal reminders ... 145
Alarm clock ... 145
Remote control option ... 145
Turn on remote control option ... 146
Add, delete, review remote control IDs ... 146
Block feature ... 147
Turning block on ... 147
Example 1: Block ... 147
Example 2: Block ... 147
Lock keypad feature ... 148
Locking the keypad ... 148
Unlocking the keypad ... 148
Selftest ... 148
User settings ... 149
Saving the settings ... 150
Restoring the settings ... 150
Clearing the settings ... 151
History ... 151
Chapter 11: Therapy management software ... 153
CareLink Personal Software ... 153
Reports ... 153
Logbook ... 154
Chapter 12: Insulin pump therapy follow-up ... 155
Recommended follow-up ... 155
Everyday ... 155
Every month ... 155
Every three months ... 155
Laboratory tests ... 156
Every visit ... 156
Annually ... 156
Chapter 13: Troubleshooting, alerts and alarms ... 157
I cannot get out of the priming loop ... 159
The pump is asking me to rewind ... 160
My bolus stopped ... 160
My pump buttons are not acting right during a bolus ... 160
My pump will not display my blood glucose reading from my meter ... 160
I dropped my pump ... 161
I submerged my pump in water ... 161
I cannot get to the USER SETTINGS screen ... 162
Alerts ... 162
Example: ... 163
What to do ... 163
Pump alert conditions ... 163
LOW RESERVOIR ... 163
LOW BATTERY ... 163
Sensor alert conditions ... 164
WEAK SIGNAL ... 164 LOST SENSOR ... 164 LOW TRANSMTR ... 165 BAD TRANSMTR ... 165 BAD SENSOR ... 165 SENSOR END ... 165 CAL ERROR ... 166 METER BG NOW ... 166 METER BG BY ... 166 LOW X.X MMOL/L (XX MG/DL) ... 166 HIGH XX.X MMOL/L (XXX MG/DL) ... 167 SENSOR ERROR ... 167 Alarms ... 167 What to do ... 168 Alarm conditions ... 168 A (ALARM) ... 168 AUTO OFF ... 168
BATT OUT LIMIT ... 168
BOLUS STOPPED ... 168
BUTTON ERROR ... 169
CHECK SETTINGS ... 169
E (ERROR) ... 169
EMPTY RESERVOIR ... 169
FAILED BATT TEST ... 169
MAX DELIVERY ... 170 MOTOR ERROR ... 170 NO DELIVERY ... 170 NO RESERVOIR ... 170 OFF NO POWER ... 170 RESET ... 170 WEAK BATTERY ... 170
Testing the transmitter ... 171
Connecting the tester ... 171
Disconnecting the tester ... 172
Troubleshooting sensor features ... 172
Reconnect old sensor ... 172
Find lost sensor ... 173
Understanding your transmitter, tester, and charger ... 173
Chapter 14: Maintenance ... 175
Battery ... 175
Storage ... 176
Cleaning your pump ... 176
Cleaning the transmitter ... 176
Cleaning the Serter ... 177
Chapter 15: Pump specifications ... 179
Alarms and error messages ... 179
Alarm history ... 179 Audio frequency ... 179 Backlight ... 179 Basal ... 180 BG target ... 180 Bolus delivery ... 180 Bolus history ... 181
Daily totals ... 181
Default screen ... 181
Delivery accuracy ... 182
Pump motor ... 182
Dual Wave bolus ... 183
Easy bolus ... 183
Infusion pressure ... 183
Insulin sensitivity ... 183
Low resv (reservoir) warning ... 184
Meter value ... 184
Normal bolus ... 184
Occlusion detection ... 184
Percent temp basal ... 184
Power supply ... 185
Prime function ... 185
Prime history ... 185
Program safety checks ... 185
Pump size ... 185
Pump weight ... 185
Remote control ... 185
Reservoir ... 186
Square Wave bolus ... 186
Temporary (temp) basal rate ... 186
Time and date screen ... 186
Environmental conditions ... 186
Status screen ... 186
Bolus Wizard feature specifications ... 188
Bolus Wizard feature examples ... 191
Insulin delivery default settings ... 194
Bolus Wizard feature default settings ... 195
Sensor features default settings ... 196
Guidance and manufacturer's declaration ... 197
Icon table ... 203
Glossary ... 205
Index ... 213
Introduction
Thank you for choosing Medtronic Diabetes (legally known as Medtronic MiniMed, Inc.) as your partner in helping you gain better control of your diabetes. Whether you are beginning pump therapy for the first time or upgrading from a previous model, we believe that the combination of state-of-the-art technology and the simple, menu-driven programming of the pump will provide many benefits.
This user guide is designed to help you to understand pump therapy and the operation of your Medtronic MiniMed Paradigm® pump. We strongly recommend that you work closely with your healthcare professional
for a safe and complete pump start.
Assistance
Please contact your local help line or representative for assistance. Refer to the Medtronic Diabetes
International Contacts list at the beginning of this user guide for the help line or representative in your area.
Emergency kit
Keep an emergency kit with you at all times to make sure that you always have necessary supplies. Inform a family member, co-worker, and/or friend where this emergency kit is kept. Please refer to the User safety section in this chapter for more information on pump safety. Your emergency kit should include these items:
• Fast-acting glucose tablets
• Blood glucose monitoring supplies
• Urine ketone monitoring supplies
• Extra Paradigm® compatible infusion set and Paradigm reservoir
• Insulin syringe and fast-acting insulin (with dosage instructions from your healthcare professional)
• Wallet card
• Dressing and adhesive
• Glucagon Emergency Kit®
• Extra AAA alkaline batteries (Energizer® brand is recommended)
Introduction 1
CAUTION: If you give yourself insulin by using a syringe, the Bolus Wizard feature will not be able to correctly determine the active insulin in your system. Consult with your healthcare professional on how long you need to wait after a manual injection before you can rely on the active insulin calculation of your Bolus Wizard feature.
Consumables
The pumps use disposable reservoirs and infusion sets for insulin delivery. Installation instructions for Paradigm reservoir and Paradigm compatible infusion sets are provided in the Starting on insulin chapter.
• Reservoirs — The 522 pump is only used with the 176-unit Paradigm reservoir (MMT-326A). The 722 pump
can be used with either the 300-unit Paradigm reservoir (MMT-332A) or the 176-unit reservoir, depending on your insulin needs.
• Infusion sets — Medtronic Diabetes provides a variety of Paradigm-compatible infusion sets to fit your
needs. Contact your healthcare professional for help in choosing an infusion set that fits your needs. Change your infusion set every two to three days.
WARNING: For your protection the pump has undergone extensive testing to confirm appropriate operation when used with Paradigm reservoirs and Paradigm compatible infusion sets manufactured or distributed by Medtronic Diabetes. We recommend using Medtronic Diabetes infusion sets and reservoirs as we cannot guarantee appropriate operation if the pump is used with reservoirs or infusion sets offered by third-parties and therefore we are not responsible for any injury or malfunctioning of the pump that may occur in association with such use.
Accessories
• Meter — Your pump can be used with an optional blood glucose meter powered by MWT1 technology
(where or if available). MWT1 is the wireless Radio Frequency (RF) technology that is used to transmit information from the meter to the pump. You can program your pump to automatically receive your BG reading from this meter. All meters referenced in this user guide are blood glucose meters supported by MWT1 technology.
• Remote control — The optional Paradigm remote control can be used with the pump to deliver normal
boluses and suspend/resume the pump from a distant location. (This user guide provides programming instructions for the remote control. Refer to the remote control user guide for operating instructions.)
• Sensor — The sensor (MMT-7002/MMT-7003/MMT-7008) continuously converts tiny amounts of glucose from your fatty layer under the skin into an electronic signal. This signal is sent to the transmitter.
• CareLink USB Upload Device — The Medtronic Diabetes CareLink USB (MMT-7305) is used to download
the Paradigm 522 or 722 pump data to the diabetes management software using a USB port on your computer.
Not all devices or accessories are available in all countries where the pump is approved.
To order supplies, contact your local representative. Refer to the enclosed contact card for the Medtronic Diabetes office in your area.
How to wear your pump
There are different ways to wear your pump. Medtronic Diabetes has optional accessories that can hide, protect, and add to the convenience of wearing a pump. Refer to the accessories catalog for more information.
• Holster — To wear the pump on your belt.
• Pump clip — To wear the pump underneath your clothing.
• Activity guard — If you are active in sports, or you are a child, use the guard to protect the pump from
disconnecting.
• Leather case — Fine leather lined with nylon. Styling complements business and formal wear. Velcro
flap provides easy access for programming. Wear it vertically with the built-in belt clip.
How to use this guide
NOTE:
This user guide shows sample screens only. Your pump screens may be slightly different. For step-by-step instructions, refer to the appropriate sections in this guide. Refer to the Glossary for definitions of terms and functions. The terms and symbols used in this guide are in the table below.Conventions Meaning
Press to push and release the button
Hold to push and keep pressure on the button
Select to press or to highlight a screen item you want to select Exit the menus press ESC until the HOME screen appears
Introduction 3
Conventions Meaning
Pump buttons always bold and uppercase; for example, ESC, ACT
Screen and menu names always uppercase; for example, MAIN MENU, REWIND screen Menu selections always bold; for example, 24-Hour Setup, On, Off
Flashing (blinking) screen item you can change the value for that item with the or buttons
NOTE and TIP additional helpful information
CAUTION warns of a potential hazard which, if not avoided, may result in minor
or moderate injury to the equipment WARNING
notifies you of a potential hazard which, if not avoided, could result in death or serious injury. It may also describe potential serious adverse reactions and safety hazards
Go to the...screen.
when a step instructs you to go to a certain screen, the path to that screen is shown. For example:
Go to the ALARM MENU. Main > Utilities > Alarm
1 From the MAIN MENU, select Utilities and press ACT. 2 In the UTILITIES MENU, select Alarm and press ACT. 3 The ALARM MENU appears.
User safety
Indications
The Paradigm 522/722 pump systems are indicated for the continuous delivery of insulin, at set and variable rates, for the management of diabetes mellitus in persons requiring insulin. In addition, the pump system is indicated for continuous or periodic monitoring of glucose levels in the fluid under the skin, and possible low and high blood glucose episodes. The pump displays continuous glucose values and stores this data so that it can be analyzed to track patterns and improve diabetes management. Pump history can be downloaded to a computer for analysis of historical glucose values.
The continuous glucose values provided by the Paradigm 522/722 pump systems are not intended to be used directly for making therapy adjustments. Rather, they provide an indication that a confirmation fingerstick measurement may be required. All therapy adjustments should be based on measurements obtained using a home glucose monitor and not based on the value displayed by the pump.
Contraindications
Pump therapy is not recommended for people who are unwilling or unable to perform a minimum of four blood glucose tests per day and to maintain contact with their healthcare professional. Successful insulin pump therapy requires sufficient vision or hearing to allow recognition of the pump signals and alarms.
Warnings
Reservoir and infusion sets
Standard Luer sets are not compatible with the Medtronic MiniMed Paradigm pump. Medtronic Diabetes Paradigm reservoirs and Paradigm-compatible infusion sets are specifically designed for use with the pump. Do not modify your Paradigm reservoir or Paradigm-compatible infusion set.
Do not put any other drugs/medications inside your reservoir to use with this pump. Only insulin that has been prescribed by your physician can be used in this pump.
Sensor
The sensor may create special needs regarding your medical conditions or medications. Please discuss these conditions and medications with your doctor before using the sensor.
Bleeding, swelling, irritation and/or infection at the insertion site are possible risks associated with inserting the sensor and sometimes result from improper insertion and maintenance of insertion site.
Transmitter
Product contains small parts and may pose a choking hazard for young children.
Optional occlusive dressing should be removed if irritation or reaction to this develops.
Magnetic fields
Do not use pump cases that have a magnetic clasp.
Do not expose your insulin pump to MRI equipment or other devices that generate very strong magnetic fields.
The magnetic fields in the immediate vicinity of these devices can damage the part of the pump’s motor that regulates insulin delivery, possibly resulting in over-delivery and severe hypoglycemia.
Introduction 5
Your pump must be removed and kept outside the room during magnetic resonance imaging (MRI) procedures.
If your pump is inadvertently exposed to a strong magnetic field, discontinue use and contact your local help line or representative for further assistance.
X-rays, MRIs and CT scans
If you are going to have an X-ray, CT scan, MRI or other type of exposure to radiation, take off your pump, sensor, transmitter, meter and remote control before entering a room containing any of these equipment. The Paradigm pump is designed to withstand common electromagnetic interference, including airport security systems. Be sure to carry the Emergency Card provided, when you are traveling. This card provides airport information.
Precautions
Although the pump has multiple safety alarms, it cannot notify you if the set is leaking or the insulin has lost its potency. It is essential, therefore, that you test your blood glucose levels at least four times per day. If your blood glucose is out of range, check the pump and the infusion set to ensure that the necessary amount of insulin is being delivered.
Avoid extreme temperatures
1 Avoid exposure of your pump and remote control to temperatures above 42°C (108°F) or below 1°C (34°F).
2 Insulin solutions freeze near 0°C (32°F) and degrade at high temperatures. If you are outside in cold weather, wear your pump close to your body and cover it with warm clothing. If you are in a warm environment, take measures to keep your pump and insulin cool.
Infusion sets and sites
Avoid using an infusion set insertion site that will be irritated by clothing and accessories, or by rigorous stretching and exercise.
Sensor
Prior to exercising, make sure the sensor is firmly attached.
Adverse reactions
Operation of the sensor feature requires the insertion of a glucose sensor into the skin. Bleeding, swelling, bruising, or infection at the sensor insertion site are possible risks of sensor use. The sensor should be removed if redness, pain, tenderness or swelling develop at the insertion site. The optional occlusive dressing should be removed if irritation or a reaction to this develops. Contact your doctor and your local representative in the event of any adverse reaction.
Notice
CAUTION: Any changes or modifications to the devices not expressly approved by Medtronic Diabetes could void your ability to operate the equipment.
Insulin pump and RF accessories
The pump, meter, transmitter and remote control comply with the United States Federal Communications Commission and international standards for electromagnetic compatibility.
Do not use the RF meter to send your blood glucose reading to the pump while on an aircraft. Manually enter your blood glucose.
These devices comply with Part 15 of the FCC Rules. Operation is subject to the following two conditions: (1) This device may not cause harmful interference, and (2) this device must accept any interference received, including interference that may cause undesirable operation. It does not interfere with any RF signals transmitted from outside sources.
Introduction 7
These standards are designed to provide reasonable protection against excessive radio frequency
interference and prevent undesirable operation of the device from unwanted electromagnetic interference. Operation is subject to the following two conditions:
1 This device has been tested and found to comply with the regulations governing such devices in your area. For the specific regulation and test results for your area, please contact your local representative. 2 This device generates, uses, and can radiate radio frequency energy and, if installed and used in
accordance with the instruction, may cause harmful interference to radio communications. If the device does cause interference to radio or television reception, you are encouraged to try to correct the interference by one or more of the following measures:
• Reorient or relocate the insulin pump/remote control/transmitter/meter
• Increase the separation between the insulin pump/remote control/transmitter/meter and the device that is receiving/emitting interference
The meter and the transmitter send information to the pump using radio frequency. If other devices that use radio frequency are in use, such as cell phones, cordless phones and wireless networks, they may prevent communication between the pump and the meter. This interference will not cause any incorrect data to be sent and will not cause any harm to your pump or meter. Moving away from or turning off these other devices may allow communication. Refer to the Troubleshooting, alerts and alarms chapter to correct interference problems you may have.
Wireless transmission between the pump and transmitter within the 1.8 meters (6 feet) operating range may be interrupted due to the transmitter orientation and the pump position on the body. Move the pump closer to the transmitter or to another position. If a Lost Sensor alarm has occurred retry: Main > Sensor > Sensor Start > Find Lost Sensor
If you have questions, please contact your local Medtronic Diabetes representative.
RF interference from other devices
Common consumer electronic devices that transmit in the same frequency band used by the MMT-7703 MiniLink transmitter may prevent the pump from receiving the glucose information sent by the transmitter. Most cellular (mobile) phones and 900 MHz cordless phones, when transmitting or receiving, may cause significant interruption of transmitter-receiver communication. It is likely that other devices operating in similar frequency ranges will have a similar effect. This interference, however, will not cause any incorrect data to be sent and will not cause any harm to your transmitter.
Communication problems can usually be resolved by:
• ensuring that there is less than 1.8 meters (6 feet) between the receiving device and transmitter, to include RF glucose meters;
• turning off or moving away from other RF transmitting devices; or
• reorienting or relocating the transmitter or receiving device, or both.
Communications problems may also occur due to cellular telephone interference. Testing conducted with several different cellular telephones indicates that, while a glucose value is being transmitted, using a cell phone within 31 cm (12 inches) of receiving devices, transmitters or RF glucose meters can interfere with reception of the transmitted values. In the event of such interference, normal communication can be re-established by:
• turning the cell phone off; or
• keeping the cell phone at least 31 cm (12 inches) away from the receiving device, transmitter or glucose meter when a glucose measurement is being transmitted.
If you have questions, please contact your local Medtronic Diabetes representative.
Introduction 9
Introduction to pump therapy
Theory of insulin pump therapy
Insulin pumps deliver insulin closer to the way the human pancreas delivers insulin than any other method of treating diabetes.
All people, with or without diabetes, need background insulin for normal functions of the body without food. They also need a dose of insulin on demand - when food is eaten. People without diabetes can trust that their pancreas will produce this insulin for them. People with diabetes need to take insulin in a way that is most like the way a pancreas produces it.
Most people with diabetes who take more than one daily injection, use long-acting insulin. This takes care of their background insulin needs. They take fast-acting insulin for food. When using an insulin pump, only fast-acting insulin is used. You control when and at what rate your insulin is delivered.
Insulin pump therapy allows you to set a basal rate, or background insulin. This is delivered all throughout the day and night for normal body function without food. When you exercise, you can reduce the basal rate so that your blood glucose (BG) does not drop too low. When you are sick or have an infection, you can increase the basal rate. This will keep your BG from going up too high.
Insulin pump therapy allows you to give a bolus, or dose of insulin on demand - when you eat. You can also increase or decrease your meal bolus based on the foods you choose to eat. A bolus may also be used to lower an elevated BG. This is called a correction bolus.
The Paradigm pump also contains an optional feature called the Bolus Wizard. This does the math for the required bolus amount based on your personal settings. The Bolus Wizard will use your BG reading, carbohydrate intake, and active insulin when coming up with your bolus amount.
Remember, the pump uses only fast-acting insulin. This means you will not need to follow as rigid a schedule as you did before. There is no long-acting insulin telling you when you should eat or when you will need more insulin.
Sound exciting? It is exciting because not only can you manage your blood glucose more easily, your lifestyle can be easier too.
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As long as you are ready to learn how to use the pump, the pump can work for you.
Understanding pump therapy
If you are new to pump therapy, you will need the following data from your healthcare professional. Gather this before going to your pump start appointment. If you are unsure, contact your healthcare professional or pump trainer for guidance.
Basal rate
Basal insulin is needed to maintain your target glucose values when you are not eating. Your pump allows up to 48 basal rates to be programmed. Your healthcare professional may only have you program one or two basal rates when you start pump therapy.
Meal bolus
Deliver a meal bolus before eating carbohydrates. Your insulin to carbohydrate ratio is the amount of insulin required to cover a given number of carbohydrates or exchanges. This ratio gives you an idea of how much of an insulin bolus you should take when eating carbohydrates.
Gram counting
1.0 unit of insulin for __________ grams of carbohydrate
Exchange counting
__________ units of insulin for each carbohydrate exchange
BG targets
The Bolus Wizard will use your BG targets to calculate a correction dose. Keeping your BG within target range is key to living well with diabetes. Your healthcare professional should help you decide these targets.
Insulin sensitivity
Insulin sensitivity is used to decide a correction bolus for a high BG. This is how much your blood glucose will be dropped with 1 unit of insulin.
Active Insulin
Active insulin is the bolus insulin that has already been delivered to your body, but has not yet been used. The pump considers your active insulin time setting in determining any active insulin still in your body from prior boluses. This may help prevent hypoglycemia caused by over-correcting for high blood glucose.
Blood glucose and A1C testing
When you check your blood glucose with a meter, you measure blood glucose at the moment you perform the test. This number gives you key feedback for making present and day-to-day adjustments in your diabetes management. The A1C test, done at your doctor's, shows you your average blood glucose over the last 60 to 90 days. Both blood glucose and A1C testing are necessary for good diabetes management.
BG testing
With any insulin therapy, you must monitor your blood glucose four to six times a day. With insulin pump therapy, blood glucose testing gives you correct feedback. It also allows you to make prompt changes based on the results. It alerts you to high blood glucose readings that need changing. It allows you to adjust your insulin to carbohydrate ratio for certain foods. Your pump only uses fast-acting insulin; as a result, you have no long-acting insulin as a back-up. Therefore, if your insulin delivery is disrupted on pump therapy, your blood glucose can go dangerously high fairly fast. This can happen much faster than it could when you were using daily injections with long-acting insulin. Blood glucose testing is needed to alert you to high blood glucose so you can prevent diabetic ketoacidosis (DKA).
A1C
A1C testing also plays a key part in diabetes management. Sustained high BG levels can cause serious long-term problems. These problems may be prevented and/or delayed if you maintain your blood glucose levels close to normal. The best measure of your overall blood glucose is the A1C test. It has been proven that an A1C level of 7.0 or less greatly reduces the risk of problems from diabetes. But, any reduction in A1C is a plus. ADA Clinical Practice Recommendations state that your A1C should be tested at least every three months by your healthcare professional.
Your healthcare professional will rely on the results of your blood glucose tests to make changes in your pump settings. The results of your A1C tests are used to assess your overall blood glucose control.
If you are on pump therapy, you must test your BG at least:
• Upon waking up
• Before each meal
Introduction to pump therapy 13
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• At bedtime
• If you feel nauseous
• One hour after any BG above 13.9 mmol/L (250 mg/dL)
Below are target guidelines from the American Diabetes Association for adults with diabetes. Consult your healthcare professional to find out what your targets should be.
Summary of recommendations for adults with diabetes mellitus
Glycemic control A1C <7.0 percent
Preprandial plasma glucose (before meals) 5.0-7.2 mmol/L (90-130 mg/dL) Peak postprandial plasma glucose (1-2 hours after meals) <10.0 mmol/L (<180 mg/dL)
Correlation between A1C level and blood glucose levels
Mean plasma glucose
A1C (percent) mg/dL mmol/L
6 135 7.5 7 170 9.5 8 205 11.5 9 240 13.5 10 275 15.5 11 310 17.5 12 345 19.5
American Diabetes Association. Diabetes Care. “Tests of Glycemia in Diabetes.” & “Standards of Medical Care.” Vol. 31, Supplement 1, January 2008. S18.
Low blood glucose (hypoglycemia)
Low blood glucose can occur while using the pump for the same reasons it can while using daily injections:
As you know, you cannot always avoid low blood glucose. It is important that you create a routine to follow when your BG is low. If you have a routine, you will have something ready to treat a low BG. This makes it less likely that you will over-treat your low BG, and cause your BG to go up too much.
It is best to use something that you can always carry with you. Choose a food that is all carbohydrate because it will be fast acting. Avoid using high fat foods such as chocolate. They will not work fast enough, and you may also end up over-treating your lows. When treating hypoglycemia, start with 15 grams of fast acting carbohydrates. Do not keep eating until you feel better. Eat the required amount and stop. The feelings will pass and you will be grateful that you did not overdo it.
Some people with diabetes know when their blood glucose is low and some do not. If you are not aware of hypoglycemia, it is important to test your blood glucose more often. Everyone with diabetes should test before driving a car to assure safety on the road. Blood glucose should be above 5.6 mmol/L (100 mg/dL) before driving and at bedtime.
Tip:
We suggest that you use glucose tablets to treat a low. These tablets contain a known, pre-measured amount of carbohydrate, and are in handy packages that you can carry in your pocket, purse, or car.Hypoglycemia protocol: the rule of 15
Check with your healthcare professional for guidelines on treating your low BG. The following instructions are commonly used to treat a BG that is 3.9 mmol/L (70 mg/dL) or lower:
1 Eat 15 grams of fast acting carbohydrate.
2 Check BG again in 15 minutes; if not above 3.9 mmol/L (70 mg/dL), repeat treatment.
3 Check BG every 15 minutes, and repeat treatment until your BG is above 3.9 mmol/L (70 mg/dL). 4 Contact your healthcare professional if your BG does not go above 3.9 mmol/L (70 mg/dL) after repeated
treatment.
These items have 15 grams of fast acting carbohydrates:
• Glucose tablets (three, 5-gram tablets or four, 4-gram tablets)
• 120 mL of juice or soda (not diet)
• 6-7 Life Savers® (hard candies) • 15 mL of table sugar or honey
Introduction to pump therapy 15
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High blood glucose (hyperglycemia)
High blood glucose can occur while using the pump for the same reasons it can while using daily injections:
• too much food
• not enough insulin
• loss of insulin strength
• disruption of insulin delivery from the pump
The goal of treating hyperglycemia is to prevent Diabetic Ketoacidosis (DKA) and delay or prevent diabetes problems due to high blood glucose over a lengthy period of time.
If for any reason you are not getting the proper amount of insulin, your blood glucose rises quickly. This can occur with insulin pump therapy from the disruption of insulin delivery. This happens from the infusion set coming out, clogs, or leaks, or insulin not being absorbed right.
Since the pump only delivers fast-acting insulin, hyperglycemia can occur rapidly. Your healthcare
professional will give you data needed for you to determine your correction bolus. This correction dose is based on your insulin sensitivity.
It is vital that you know these guidelines in the hyperglycemia protocol.
Hyperglycemia protocol
If one blood glucose reading is above 13.9 mmol/L (250 mg/dL):
• Take a correction bolus right away.
• Test BG in one hour.
If the second blood glucose is above 13.9 mmol/L (250 mg/dL):
• Take an insulin injection by syringe (not through the pump). The amount should be the same as if you were taking a correction bolus.
• Change the entire infusion set system (new reservoir, infusion set, and cannula). Consider changing the insulin vial if you believe that the insulin is no longer stable.
• Check urine for ketones and call your healthcare professional if ketones are present.
• Drink liquid with no calories every 30 minutes (for example: 240 mL diet ginger ale, broth, water).
Diabetes ketoacidosis (DKA)
DKA results from untreated hyperglycemia. DKA is a serious medical problem that needs treatment right away. The insulin pump therapy uses only fast-acting insulin, so DKA can occur rapidly if insulin delivery is disrupted. It is important that you understand these guidelines.
Preventing DKA
If you have nausea or vomiting, immediately check your blood glucose and ketones. If your blood glucose is above 13.9 mmol/L (250 mg/dL)and/or ketones are present:
• Take an injection of fast-acting or regular-acting insulin with a syringe (not through the pump). The amount should be the same as if you were taking a correction bolus. If ketones are present, more insulin may be needed. Contact your healthcare professional for guidelines for insulin doses especially when ketones are present.
• Change the entire infusion set system (new reservoir, infusion set, and cannula). Consider changing the insulin vial if you believe that the insulin is no longer stable.
• Call your healthcare professional.
• Troubleshoot the pump. If you need help, please refer to the Medtronic Diabetes International Contacts list at the beginning of this user guide for your local representative.
• Drink liquids with no calories every 30 minutes (for example: 240 mL diet ginger ale, broth, water).
• Check your blood glucose and ketones in one hour.
• Continue to take insulin as discussed with your healthcare professional.
• Call your healthcare professional right away if your blood glucose and ketones are not decreasing, or you cannot drink fluids.
• Continue to test blood glucose and ketones. Continue to take correction insulin injections as told until your blood glucose reaches your target level.
• If your blood glucose is less than 11.1 mmol/L (200 mg/dL) and ketones are present, drink liquids with calories. Some examples of caloric fluids are juice and non-diet soda. Also, extra insulin may be needed. Contact your healthcare professional for guidelines for insulin doses when ketones are present.
Tip:
You should have a meter, glucose strips, and ketones strips handy at all times. This way you are always ready to test your blood glucose and ketones.Introduction to pump therapy 17
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Sick day management
Managing diabetes during an illness or infection requires frequent blood glucose and urine ketone testing. Illness and infection put extra stress on the body and often raise blood glucose. The insulin pump allows you to make changes. It lets you quickly and easily respond to blood glucose changes due to illness and infection.
Even if you are not able to eat, you need insulin. Depending on blood glucose testing, you may or may not need to adjust your basal insulin to cover your needs. You may also need to take frequent correction boluses during illness.
Sick day protocol
• Test your blood glucose every two hours, 24 hours a day.
• Check urine ketones every time you urinate.
• If you are throwing up and/or have ketones, you must call your healthcare professional. They will give you the proper treatment with fluids and insulin to avoid DKA.
• Consult your healthcare professional about taking more insulin if your blood glucose is 13.9 mmol/L (250 mg/dL) or higher. Also take more insulin when ketones are fair or large.
• Keep exact records of your blood glucose values, ketones, medication, temperature and all other signs.
• Keep in mind that you need more insulin and fluids when there are urine ketones. This is true even if your blood glucose is within your target range.
Sick day supplies
You should have the supplies listed below in the house at all times, and carry them with you when you travel:
• Fluids that have sugar (regular soda, juice, jello) to replace solid food.
• Sugar-free liquids (diet drinks, bouillon, water) for replacing lost fluids.
• Thermometer.
• Sugar free medicine for fever, cough, congestion, nausea and vomiting.
• Extra blood glucose and ketone strips.
• Glucagon emergency kit in case of severe hypoglycemia. This can be used if you cannot eat or are unconscious.
Nutrition
Good nutrition and making healthy choices are important for everyone. Additionally, for those with diabetes, it is more important to know the nutrient content in food, and how the nutrients affect blood glucose. Carbohydrates have the most effect on blood glucose, notably within a few hours of being eaten. Counting carbohydrates allows you to match your insulin dose to the food you are eating. This is your insulin to carbohydrate ratio. Although fat and protein can affect your blood glucose when eaten in large amounts, carbohydrates affect blood glucose the most.
Consult with your healthcare professional for your personal nutritional guidelines.
Carbohydrate counting
With insulin pump therapy, you must take a bolus for the carbohydrates you eat. You need to count the carbohydrates you plan to eat to see how much insulin to take.
There are two basic methods to count carbohydrates, and in truth, they are very much alike. Many people use parts of both of the two methods.
Carbohydrate gram counting
With this method, you add up the exact number of grams of carbohydrate in each meal. Food labels, food list and meal planning books are great tools for carbohydrate gram counting.
Carbohydrate exchange system
This method uses food groups called exchange groups. One exchange with carbohydrate has about 15 grams of carbohydrate.
1 bread exchange 1 fruit exchange 1 milk exchange
15 grams carbohydrate 15 grams carbohydrate 12 to 15 grams carbohydrate Foods with carbohydrates include:
• starches and starchy vegetables
• fruits and fruit juices
• milk and milk products
• sugars and foods with sugar
Introduction to pump therapy 19
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Facts on the nutrition labels on packaged food will help you to figure how much carbohydrate is in a certain food. There are a number of paperback books that list the grams of carbohydrates in many foods. These books are very helpful when you are eating foods without labels or are eating out. Also, if you know the exchange system, you can count carbohydrate exchanges.
Your healthcare professional will give you an insulin to carbohydrate ratio at the start. This will be a place to begin. It may need to be changed based on the results of your blood glucose readings after you eat. Determining your meal bolus based on carbohydrate counting is not an exact science. Sometimes it takes trial and error to come up with the correct meal bolus for certain foods. If you are not sure how some foods affect your blood glucose, test your blood glucose two hours after eating. If your reading is too high or too low, adjust your meal bolus the next time you make that food choice.
As you start to learn carbohydrate counting, try to assess the carbohydrates in the food you are eating. Then look at the food labels to see how close you are.
Reading a food label
Use the Serving Size and Total Carbohydrates information on the food label to determine how many total grams of carbohydrate you will be eating. Then, use the insulin to carbohydrate ratio prescribed by your healthcare professional. This allows you to figure out how much insulin to take for the foods you eat. The following food label shows 12 grams of carbohydrates for each 1 piece serving. If your carbohydrate ratio is 1 unit of insulin for every 12 grams of carbohydrate, you would need 1 unit of insulin for each 1 piece serving of this food.
Nutrition Facts Serving Size 1 piece (20g)
Serving per Container 22 Amount Per Serving:
Calories: 50 Fat Calories: 0 Total Fat 0g Sodium 0g
Fat and blood glucose
Although fat does not have carbohydrate, it may affect your blood glucose level. Your blood glucose can be normal two hours after a meal with high fat foods. However, four to six hours later your blood glucose will increase. That is because the fat slows down the rate the carbohydrates are absorbed in that meal.
Foods with fat include:
• margarine • oils • mayonnaise
• salad dressing • nuts • fried foods
• butter • sour cream • whole milk
• cream cheese • bacon • high fat meats
Doctors and health experts suggest that all people, with or without diabetes, eat less total fat—namely less saturated fat. If you have high cholesterol or are trying to lose weight, it is key to limit the amount of fat you eat per day.
There are bolus type options available on your pump that can be helpful in handling the rare high-fat meal. Before using bolus type options, you should be at ease using basic pump features and consult with your healthcare professional.
Protein and blood glucose
Protein has little effect on blood glucose when eaten in moderate amounts, and normally does not require any insulin.
Sources of protein include:
• meat • fish • poultry
• eggs • cheese • peanut butter
• tofu • dried beans • dried peas
Protein needs are the same for people with and without diabetes, unless kidney disease is present. Most people eat more protein than they need. Protein does not need to be part of every meal. In general, 140-200 grams of protein a day is enough. If you have high cholesterol or are trying to lose weight, eat leaner proteins such as chicken and fish.
Introduction to pump therapy 21
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Other things that affect blood glucose
Fiber may slow down the rise in blood glucose after a meal. Fiber grams are not absorbed. They can be subtracted from the Total Carbohydrate amount for foods or meals with more than 5 grams of fiber. Fiber is an important part of a healthy diet. Suggestions for fiber intake are the same for people with and without diabetes.
Sodium (salt) has no effect on blood glucose. Moderate sodium intake is suggested for people with or without diabetes. If you have high blood pressure or are affected by sodium, limit the amount of sodium in your diet. Alcohol can cause low blood glucose by slowing down the release of glucose from the liver. This glucose release keeps blood glucose in target between meals. Therefore, food should be eaten while having a drink with alcohol. The carbohydrate content of different types of alcohol can be found in carbohydrate counting books. Consult your healthcare professional for guidelines on bolusing for alcohol.
Vitamins and minerals have no effect on blood glucose.
Healthy eating habits
Insulin pump therapy gives you the choice of when, what and how much to eat without impacting blood glucose control. This gives you the flexibility to sleep-in, postpone or skip meals, and eat snacks—the same as people who do not have diabetes. Be careful to not abuse this freedom and compromise your nutritional health. All people need to make healthy food choices to be mentally and physically healthy.
It is not an exact science to figure your meal bolus based on carbohydrate counting. Sometimes it takes trial and error to figure the correct meal bolus for certain foods. If you are unsure how certain foods will affect your blood glucose, test your blood glucose two hours after you eat. Keep records of foods that you eat on regular basis. Note the bolus amounts and post-prandial readings for each entry. If your reading is too high or too low, adjust your meal bolus the next time you make that food choice.
Exercise
Your body needs insulin and carbohydrate to provide cells with energy during exercise. How much insulin and carbohydrates you need varies with the types of exercise and with how often you exercise. Using an insulin pump during exercise allows you to reduce your basal rate instead of eating extra carbohydrate. Before, you needed to eat extra carbohydrate to make up for the glucose lowering effect exercise often has on blood
The body needs insulin during exercise. Therefore, it is not suggested that you stop the pump unless the exercise is for a short amount of time (one hour or less). If you need to remove the pump for more than one hour, refer to the If you remove your pump section in The basics chapter.
If you do an exercise that on average lowers your blood glucose, you can use the temporary basal rate feature. You can use this feature to lower the amount of insulin delivered and reduce the risk of hypoglycemia. You may also choose to change your basal rate pattern for the days you exercise.
It takes a period of time to determine how much to adjust your basal rate during exercise. Record your blood glucose before, during and after exercise to figure the proper reduction in your basal rate. Record any carbohydrates that you have eaten during the exercise period. There is no magic formula that will tell you just what to do. You have to test often to figure out the basal rate that you need during exercise.
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The basics
Your pump
CAUTION: Never use sharp objects to press the buttons on your Paradigm pump as this can damage the buttons or compromise the seal of the pump. Some examples of sharp objects that may damage your keypad are fingernail files, pens or pencils, paper clips, knives, scissors, and keys.
Take a look at your pump. The reservoir window allows you to view the insulin in the reservoir. The reservoir, with the tubing connector attached, is inserted into the reservoir compartment of the pump.
reservoir window screen tubing connector reservoir compartment battery compartment buttons A C T E S C ACT ESC The basics 25 Chapter 3
Install battery
CAUTION: Do not use a rechargeable or carbon zinc battery in your pump. For best results use a new Energizer AAA alkaline battery, size E92, type LR03.
Medtronic Diabetes designed the pump to only accept a new battery. As a safety measure, if you install a battery that does not have full power, the WEAK BATTERY or FAILED BATT TEST alarm may sound. If you receive a WEAK BATTERY alarm, respond to the alarm and continue. The pump will still operate normally, but with a decreased battery life. The pump uses one AAA alkaline battery.
1 Make sure all the following apply:
• Clear (ESC, ACT) any alarms and/or alerts before removing and replacing the battery.
• Make sure the pump is at the HOME (idle) screen when you remove the battery.
• Do NOT remove the battery during a bolus or prime delivery.
2 Use the edge of a coin to remove the battery cap. Turn the cap in a counter-clockwise direction. 3 Remove the old battery and dispose of it per
the disposable requirements of your state or country. Put the new battery in the pump with the negative end [(-) symbol] going in first. Check the label on the back of the pump to make sure the battery is inserted correctly.
NOTE:
Do not use batteries that have been in cold storage, such as in the refrigerator or in your car during winter in cold climates.battery cap
battery
4 Place the battery cap in the pump and tighten so the slot is aligned horizontally with the pump as shown here:
CAUTION: Do NOT over-tighten the battery cap. You should not turn the cap more than four half turns. If you over-tighten the cap you may not be able to remove it, and you can damage your pump.
one half-turn
5 While the pump turns on, it will show one or more screens until the HOME screen appears.
If the HOME screen does not appear, do these steps:
a. Check that the battery is inserted correctly. If the battery has been installed backwards, remove the battery and install it properly.
b. If your pump still does not turn on or you get a FAILED BATT TEST alarm, remove and replace the battery with a new one.
c. If the pump is still not on, call your local help line or representative.
HOME screen
6 Check to make sure the time and date are correct. If more than five minutes have passed since you removed the battery, you will be prompted to check the time and date. Refer to the Setting the time and date section in the Basic programming chapter for programming instructions.
7 Press ESC to view the STATUS screen, making sure no alarms are active. If an alarm is active, follow the instructions on the screen.
Pump buttons
The buttons on the pump are used to navigate through the menus and screens, and to program the features of the pump. EXPRESS BOLUS button ESC button ACT button DOWN button UP button
From the HOME screen, this is the EASY BOLUS button
The basics 27
The following table describes how to use the buttons on your pump from the HOME screen:
Button Description
EASY BOLUS™ button – Shortcut to set and deliver an Easy Bolus. Turns the backlight on or off.
Opens the MAIN MENU.
• Opens the pump STATUS screen if the sensor feature is turned off.
• Opens the following screens and graphs from the HOME screen if the sensor feature is turned on:
• 1 press opens the 3–hour sensor glucose graph.
• 2 presses open the 24–hour sensor glucose graph.
• 3 presses open the pump STATUS screen.
• 4 presses open the SENSOR STATUS screen. EXPRESS BOLUS button – Shortcut to set any bolus.
The following table describes how to use the buttons on your pump from the menus and programming screens:
Button Description
Increases or decreases the value of a flashing item. Scrolls up or down the items in a list. Accepts a selected menu item or activates a selected setting.
• Returns to previous screen or exits the menu.
The pump screen
The screen shows five lines of text at one time. The first is the operating mode. The second is the current open menu or function. The last three lines show either information or text that you can select for the current function.
NOTE:
The screen text in the examples used in this guide might not exactly match the text on your pump screen. Please follow your pump screen instructions. If you have any questions, contact your localrepresentative.
HOME screen
The HOME screen serves as the starting point to access the programming screens. When no buttons are pressed for about 30 seconds, the pump returns to this screen.
When you press ACT from the HOME screen, the MAIN MENU will appear.
When the pump is on, the following icons always appear across the top of the screen: reservoir volume icon, the time (12- or 24-hr), and the battery icon. If these do not appear, the pump is not operating.
Screen icons
There are various icons that appear at the top of your pump screen, like the time, battery and reservoir icons mentioned above. The next sections describe what the icons mean.
Battery
The battery icon tells you how much usable life is left in your battery. There are four segments in the icon. Each segment represents approximately 25 percent of the usable battery life you have left until you reach Low Battery point. So if you only have one segment left, make sure you have a new battery available.
At least 75% left
Low battery
The basics 29
